Background/Purpose: TNF-α inhibitor therapy has long been the standard of care for adult patients diagnosed with moderate to severe psoriatic arthritis (PsA), though several new biologics and small molecules have recently received FDA approval for the treatment of PsA. This research sought to understand the extent to which biologics and small molecules with a different mechanism of action (MOA) have been adopted for the treatment of PsA and their impact on the use of well-established TNFs.

Methods: An independent market analytics firm collaborated with US rheumatologists (n=192) to conduct a retrospective chart review of patients diagnosed with psoriatic arthritis (PsA) (n=994), who had switched from one biologic therapy or apremilast to another in the prior twelve weeks.  Rheumatologists were able to submit up to seven PsA patient charts. Data were collected in March 2019 and included clinical and non-clinical patient demographics, as well as physician demographics and attitudinal survey responses.  This study was a non-longitudinal trending analysis to 2016, 2017, and 2018 audits following the same methodology.

Results: 83% of rheumatologists reported recent changes to the management of their PsA patients and the two most commonly recalled treatment shifts were: more aggressive/earlier use of biologics in general and increased use of non-TNF agents for the treatment of PsA.  Despite increased PsA treatment options, annual reported rates of PsA patient switching have remained stable since 2016, with rheumatologists reporting approximately one-quarter of biologic/apremilast-treated patients switch brands within a given year. Audited switches between TNF agents have significantly and consecutively decreased year-over-year: in 2016, consecutive TNF cycling accounted for 52% of audited patients, a figure that has declined with each audit and is presently just 35%.  Conversely, switches from a TNF to an alternative MOA agent have significantly increased during the same period from 13% to 30%, respectively.  The growth in the switching share of alternative MOAs is driven primarily by increased use of the IL-17 inhibitors, secukinumab and ixekizumab, as well as the oral JAK inhibitor, tofacitinib.

Conclusion: Increased biologic and small molecule options for the treatment of PsA has resulted in US rheumatologists switching fewer patients to a TNF in second- or later-lines of therapy, and a notable and significant decline in the practice of TNF cycling. Though TNF inhibitors remain the predominant MOA for the treatment of PsA, the introduction of secukinumab, ixekizumab, and tofacitinib have had a direct impact on the PsA switching environment, and in particular, use of the TNF class.

« Back to 2019 ACR/ARP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-alternate-mechanism-of-action-biologics-and-tofacitinib-on-tnf-%ce%b1-inhibitor-prescribing-in-psoriatic-arthritis-results-from-annual-national-patient-chart-audits/